Abstract
Background: Bronchoscopy is commonly performed for the diagnosis and treatment of respiratory tract diseases, but may pose a risk of oxygen desaturation, particularly in patients with certain conditions. The use of the i-gel® laryngeal mask airway (LMA) is a more practical alternative to endotracheal tubes. Inhaled lidocaine, used as a topical anesthetic for the respiratory mucosa prior to bronchoscopy, offers a lower risk of systemic side effects and is thought to be more effective in controlling hemodynamic responses than intravenous lidocaine. This study aimed to compare the effects of inhaled 2% lidocaine and intravenous 1% lidocaine on hemodynamic responses and plasma norepinephrine levels in patients undergoing bronchoscopy with the i-gel® LMA.
Methods: This was a true experimental study with a single-blind, randomized controlled clinical trial design conducted on patients undergoing bronchoscopy at Wahidin Sudirohusodo Hospital, Makassar. Patients who met the inclusion and exclusion criteria were selected using a consecutive sampling method. Group A received inhaled 2% lidocaine, and Group B received intravenous 1% lidocaine. Observed parameters included hemodynamic measurements and plasma norepinephrine levels at three different time points.
Results: A total of 46 patients were included in the study. The mean age of subjects was 54.52±13.29 years in the inhaled 2% lidocaine group and 55.87±13.01 years in the intravenous 1% lidocaine group. There were no statistically significant differences between the groups in baseline characteristics, including age, gender, body mass index (BMI), and American Society of Anesthesiologists Physical Status (ASA PS). However, the group receiving inhaled 2% lidocaine exhibited significantly more stable hemodynamic responses during the bronchoscopy procedure compared to the group receiving intravenous 1% lidocaine. This was evidenced by smaller changes (delta) from baseline values in systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure, and plasma norepinephrine levels.
Conclusion: Inhaled 2% lidocaine is more effective than intravenous 1% lidocaine in attenuating hemodynamic responses and reducing plasma norepinephrine levels during bronchoscopy procedures using the i-gel® LMA.
Daud Yusuf, Andi Adil, Syafruddin Gaus, Andi Husni Tanra, Faisal Muchtar, Madonna D. Datu
